CurrentUnitedHealthcarePolicy CS076LA.M

Manipulative Therapy (for Louisiana Only) Retired April 1, 2026

State-specific UnitedHealthcare Community Plan medical policy for manipulative therapy (chiropractic and osteopathic manipulative treatment) that applies only to Louisiana enrollees and defines covered indications, exclusions, documentation and applicable procedure codes for the policy effective Sept 1, 2025–Mar 31, 2026 (policy retired April 1, 2026).

Policy Summary

PayerUnitedHealthcare

PolicyManipulative Therapy (for Louisiana Only) Retired April 1, 2026

Policy CodePolicy CS076LA.M

Change TypeRetired; state-specific clarifications

Effective DateSept 1, 2025 - Mar 31, 2026

Next Review DateN/A

Key ActionProviders must document an initial treatment plan (level of care, treatment goals, measures of effectiveness) and record progress at follow-up visits; EPSDT referral is required for enrollees under 21.

SourceLink

POLICY UPDATE CHANGES

Policy labeled as retired April 1, 2026; effective date range listed as September 1, 2025 - March 31, 2026.

State-specific criteria: Chiropractic services for enrollees under 21 clarified — chiropractic manipulative treatment when medically necessary and upon EPSDT referral.

Specified required content for initial and follow-up visits (treatment plan, goals, measures of effectiveness, progress documentation).

State-specific criteria for adults 21+ clarified that chiropractic services for diagnosing/treating neuromusculoskeletal conditions are covered and that spinal manipulation of up to five regions is medically necessary when included in the documented treatment plan.

Non-state-specific criteria revised to specify 'osteopathic Manipulative Therapy' is proven and medically necessary for treating musculoskeletal disorders, replacing a more general 'Manipulative Therapy' statement.

Definition added for 'Upledger Technique'.

Updated literature and references list (09/01/2025).

Louisiana-onlyState applicability

Under 21: EPSDT referral requiredPediatric chiropractic coverage note

Up to 5Adult chiropractic manipulation coverage

Listed techniquesNot medically necessary for non-MSD or nonstandard techniques

Multiple SRs/RCTsEvidence sources summarized

1Policy retired for Louisiana

When Manipulative Therapy Is Covered or Not Covered

Chiropractic Services for Under 21 Years of Age (EPSDT)

Chiropractic manipulative treatment for enrollees under 21 is covered when ALL of the following are met:

ALL of the following

Patient is under 21 years of age
Service is medically necessary
Referral from an EPSDT medical screening primary care provider is present

Chiropractic Services for Adults Age 21 and Older

Chiropractic services for diagnosis and treatment of neuromusculoskeletal conditions associated with spinal functional integrity are covered when ALL of the following are met:

ALL of the following

Patient is age 21 or older
Diagnosis is a neuromusculoskeletal condition associated with functional integrity of the spine (i.e., musculoskeletal disorder)
Chiropractic spinal manipulation involves up to five regions when included in the documented treatment plan
Policy explicitly allows spinal manipulation of up to five regions as medically necessary when in treatment plan
Initial visit includes a treatment plan containing level of care (duration and frequency), treatment goals, and measures to assess effectiveness (qualitative and/or quantitative)
Follow-up visits document enrollee progress and measures used to assess effectiveness

Osteopathic Manipulative Services

Osteopathic Manipulative Therapy (OMT) is considered medically necessary for musculoskeletal disorders; it is unproven and not medically necessary for non-musculoskeletal indications and certain techniques. Coverage when ALL of the following are met:

ALL of the following

Indication is a Musculoskeletal Disorder (MSD) — injuries or conditions originating from joints, muscles, ligaments, discs, or other soft tissues in the spine or limbs producing clinically relevant symptoms and functional limitations
OMT is used to diagnose/treat the MSD

Not covered / considered unproven for the following indications or techniques (ANY of):

Non-Musculoskeletal Disorders (e.g., asthma, otitis media, infantile colic, internal organ disorders)
Prevention, maintenance, or custodial care

Documentation Requirements (Adult Chiropractic)

Services must include the following documentation elements:

ALL of the following

Initial visit: treatment plan with level of care (duration/frequency), treatment goals, and measures to assess effectiveness
Follow-up visits: documentation of enrollee progress and measures used to assess effectiveness

Documentation, Prior Auth, and Denial Risks — What Providers Must Do

Documentation Required

Initial visit treatment plan required (adults)

Initial visit must include a documented treatment plan that specifies the level of care (duration and frequency of visits), treatment goals, and measures to assess effectiveness (qualitative and/or quantitative). Applicable procedure codes referenced include chiropractic and OMT codes: 98940, 98941, 98942, 98943, and 98925–98929.

Treatment plan must document: level of care (duration and frequency), treatment goals, measures to assess effectiveness (qualitative and/or quantitative).
Applicable procedure codes: 98940, 98941, 98942, 98943, 98925–98929.

Documentation Required

Follow-up visit documentation

Follow-up visits must document the enrollee's progress in the treatment plan and the measures used to assess effectiveness.

Procedure Codes Referenced and State Fee-Schedule Exclusions

Procedure codes referencedCPT/HCPCS/mixed

98925	Osteopathic manipulative treatment (OMT); 1-2 body regions involved
98926	Osteopathic manipulative treatment (OMT); 3-4 body regions involved
98927	OMT; 5-6 body regions involved
98928	OMT; 7-8 body regions involved
98929	OMT; 9-10 body regions involved
98940	Chiropractic manipulative treatment (CMT); spinal, 1-2 regions
98941	CMT; spinal, 3-4 regions
98942	CMT; spinal, 5 regions
98943	CMT; extraspinal, 1 or more regions
S8990	Physical or manipulative therapy performed for maintenance rather than restoration

State fee-schedule exclusionsmixedNot Covered

98925	Not on the State of Louisiana Medicaid Fee Schedule (listed with asterisk in document) — therefore not covered by State program
98926	Not on the State of Louisiana Medicaid Fee Schedule (asterisk)
98927	Not on the State of Louisiana Medicaid Fee Schedule (asterisk)
98928	Not on the State of Louisiana Medicaid Fee Schedule (asterisk)
98929	Not on the State of Louisiana Medicaid Fee Schedule (asterisk)
98942	Not on the State of Louisiana Medicaid Fee Schedule (asterisk)
98943	Not on the State of Louisiana Medicaid Fee Schedule (asterisk)

Clinical Background and Evidence Summaries by Condition

Manipulative therapy (including osteopathic manipulative treatment OMT, spinal manipulative therapy SMT, and chiropractic manipulative treatment CMT) uses hands-on manual techniques to assess and treat musculoskeletal disorders by moving or applying pressure to muscles, joints, and soft tissues. The policy recognizes these therapies are commonly used to diagnose, treat, and sometimes prevent structural and functional problems of the spine and extremities and may be used alone or adjunctively with other medical care.

The clinical evidence summarized in the document comes from systematic reviews, meta-analyses, and randomized controlled trials and is heterogeneous in quality and findings. For common musculoskeletal conditions (for example, acute and chronic low back pain, neck pain, some headaches, and selected extremity disorders), multiple reviews and RCTs report modest short-term benefits for pain and function versus minimal care or some comparators, while effects versus active conservative treatments are often similar. Several high-quality syntheses (Cochrane/AHRQ-level reviews and large meta-analyses) characterize the benefit size as small to moderate and note substantial heterogeneity and risk of bias across trials.

The policy emphasizes important limitations in the evidence base: many positive findings derive from small trials, short follow-up intervals, variable intervention protocols, incomplete blinding, and inconsistent outcome reporting. Systematic reviews frequently rate overall methodological quality as low to very low and call for larger, well-designed RCTs with longer-term follow-up to confirm durability and establish clinical relevance.

For non-musculoskeletal indications (for example, infantile colic, asthma, otitis media, hypertension, and other visceral or systemic claims), the best available randomized trials and consensus systematic reviews do not support clinically meaningful benefit of SMT/OMT, and the policy concludes evidence is insufficient to consider such uses proven. Similarly, craniosacral therapy and several nonstandard techniques are judged to have low-quality or inconsistent evidence and are considered unproven.

Overall, the policy's conclusion is measured: OMT/SMT/CMT can be medically necessary and helpful for specific musculoskeletal disorders with modest short-term benefit, but the evidence base has important limitations; manipulative approaches for non-musculoskeletal conditions or using nonstandard techniques lack high-quality supportive evidence and are considered unproven and not medically necessary.

Louisiana-Specific Coverage Clarifications and Requirements

State-Specific Coverage (Louisiana) — Chiropractic services

State-specific rules added/clarified (effective 2025-09-01):

ALL of the following

For enrollees under 21 years: chiropractic manipulative treatment is covered when medically necessary and upon referral from an EPSDT medical screening primary care provider.
For adults age 21 and older: chiropractic services for diagnosing and treating neuromusculoskeletal conditions associated with functional integrity of the spine are covered and considered medically necessary.
When spinal manipulation is provided for adults 21+:
- Chiropractic spinal manipulation of up to five regions is covered and considered medically necessary when included in the documented treatment plan.

Definitions of Terms Used in This Policy

Definitions

Manipulative TherapyTherapeutic application of manual pressure or force in which the practitioner moves or manipulates parts of the patient's body to achieve and maintain health; includes chiropractic treatments, physical therapy, massage, OMT/OMM.

Musculoskeletal Disorders (MSDs)Injuries or conditions originating from joints, muscles, ligaments, discs, or other soft tissues in the spine or limbs that produce clinically relevant symptoms and functional limitations.

Upledger TechniqueA complementary, light-touch craniosacral treatment technique; specifically noted as an example of craniosacral therapy in the policy.

OMTOsteopathic manipulative treatment — a set of hands-on manual therapy techniques performed by osteopathic practitioners.

MMTManual and manipulative therapy — includes mobilizations and manipulations targeting joints and soft tissues.

Policy Changes and Retirement Notes

2026-04-01retirementLatest

Policy retired for Louisiana membership; membership disenrolled effective April 1, 2026.

2025-09-01state-specific criteria added

State-specific coverage and documentation requirements effective Sept 1, 2025: EPSDT referral required for chiropractic services under age 21; adult chiropractic criteria added including allowance of spinal manipulation up to five regions and mandatory initial visit treatment plan and follow-up progress documentation.

2025-09-01terminology/definition update

Policy Summary

PayerUnitedHealthcare

PolicyManipulative Therapy (for Louisiana Only) Retired April 1, 2026

Policy CodePolicy CS076LA.M

Change TypeRetired; state-specific clarifications

Effective DateSept 1, 2025 - Mar 31, 2026

Next Review DateN/A

SourceLink

On This Page

Craniosacral therapy (cranial manipulation/Upledger Technique)

Temporomandibular joint (TMJ) disorder

Scoliosis (manual therapies for idiopathic scoliosis are considered insufficient/ unproven)

Manipulative services using nonstandard techniques (e.g., applied kinesiology including the neural organizational technique; NUCCA process)

Prior Authorization

EPSDT referral requirement for <21

For enrollees under age 21, chiropractic manipulative treatment is covered only when medically necessary and upon referral from an EPSDT medical screening primary care provider; this requirement applies to chiropractic services for under-21 enrollees in Louisiana.

Denial Risk

Non-MSD and nonstandard techniques not medically necessary

Manipulative therapy provided for non‑musculoskeletal disorders or delivered using listed nonstandard techniques (examples: applied kinesiology/ neural organizational technique; NUCCA; craniosacral therapy) is considered unproven and not medically necessary and may be denied. Relevant procedure and maintenance codes referenced include 98925–98929, 98940–98943, and S8990.

Examples of nonstandard techniques listed: applied kinesiology (including neural organizational technique), NUCCA process, craniosacral therapy (Upledger Technique).
Codes referenced for manipulative services: 98925–98929, 98940–98943, S8990.

Documentation Required

Study limitations and short-term evidence

The policy highlights that evidence is frequently limited by small sample sizes, short follow-up, heterogeneous interventions, and risk of bias; clinicians should consider these limitations when making treatment decisions.

Documentation Required

Evidence-based justification required for non-standard indications

Use of manipulation or craniosacral therapy for non‑standard, non‑musculoskeletal indications is not supported by the literature; if such indications are considered, providers should document clinical rationale and expected benefit in the medical record.

Denial Risk

Coverage risk for non-musculoskeletal indications

Spinal manipulation/OMT/CST for non‑musculoskeletal disorders is not supported by high‑quality evidence and may be considered non‑covered or experimental by payers and policy makers.

Documentation Required

Initial visit documentation required for adult chiropractic treatment plan

The initial visit for adult chiropractic care must include a treatment plan that documents level of care (duration and frequency), treatment goals, and measures to assess effectiveness (qualitative and/or quantitative).

Documentation Required

Follow-up visit documentation

Follow-up visits must include documentation of the enrollee's progress in the treatment plan and the measures used to assess effectiveness.

Prior Authorization

EPSDT referral requirement for under-21 chiropractic services (LA)

Chiropractic manipulative treatment for enrollees under 21 is covered only when medically necessary and requires referral from an EPSDT medical screening primary care provider — a Louisiana‑specific requirement.

Evidence summaries and conclusions by condition

Summarized conclusions from studies and systematic reviews for each condition:

Carpal Tunnel Syndrome (CTS)

OMT in a small trial produced participant-perceived symptom and function improvement, but no change in median nerve electrophysiology or morphology; limitations include unknown population and short follow-up.

Hip Osteoarthritis / Parkinson's gait

Single-session OMT-WB increased total sagittal hip ROM in Parkinson's disease in one RCT (short-term); waveform analyses showed no differences across gait cycle points; limitations: single session, no follow-up.
Systematic reviews: exercise more effective than minimal control for hip OA pain short-term; low-quality evidence suggests manual therapy may help short-term but larger RCTs needed.
Hoeksma RCT: manual therapy superior to exercise therapy over five weeks for hip OA with maintained benefit at 29 weeks.

Knee Osteoarthritis / Post-op TKA

Systematic review (Zhou 2022) suggests OMT may improve ROM, edema, pain, ADLs post-TKA, but included heterogeneous and lower-quality studies; more high-quality RCTs needed.
Small RCTs indicate manual therapy + exercise can be superior to exercise alone for short-term pain and function; limitations: small samples and short follow-up.
Systematic review/meta-analysis (Salahm 2017) supports manual therapy for self-reported knee function but less support for pain reduction; evidence not definitive.

Ankle and Foot

Proprioceptive exercise + manual therapy improved outcomes for recurrent ankle sprain vs exercise alone (small RCT).
MMT equivalent to night splint for mild-moderate hallux valgus short-term (small RCT).
Manual therapy + exercise produced greater benefits than electrophysical agents + exercise for plantar heel pain (Cleland 2009 RCT).

Headache (migraine, tension-type, cervicogenic)

Systematic reviews/meta-analyses show spinal manipulation/mobilization may reduce migraine days/pain and is at least as effective as other conservative treatments short-term for cervicogenic and tension-type headaches; overall evidence quality variable and at risk of bias.
Manual therapy may improve quality of life for tension-type and migraine headaches, but evidence levels are low; for cervicogenic headache mobilization has moderate evidence per Clar et al. update.

Temporomandibular Joint Disorders (TMD)

Evidence for manual therapy for TMD is limited and inconsistent: some RCTs and meta-analyses show short-term pain and mouth-opening improvement, others show no significant long-term benefit versus conservative therapy; trial limitations include small size and heterogeneity.
Dunning et al. (2024) RCT: dry needling + upper cervical spinal manipulation superior to interocclusal splint + diclofenac + TMJ mobilization at 3 months, but limitations include lack of placebo needling and potential bias.
Overall conclusion: additional high-quality long-term RCTs needed before clinical usefulness proven.

Preventive/maintenance manipulative treatment

Insufficient evidence to support manipulative therapy for prevention, maintenance, or custodial care; some trials suggest maintenance care may reduce days with bothersome LBP in selected subgroups but findings are context-dependent and require further validation.
Psychological/behavioral characteristics modify response to maintenance care; subgroup effects appear hypothesis-generating.

Non-musculoskeletal conditions (asthma, otitis media, infantile colic, hypertension, depression, etc.)

Long-term safety and effectiveness not established; small trials and feasibility studies report biomarker or short-term changes but clinical significance unknown; further high-quality RCTs required.
Feasibility trials (Hope-Bell, Pala) reported feasibility and some biomarker changes but limited clinical implications due to small samples and exploratory outcomes.

Overall evidence conclusions in this document segment

Summaries of evidence and conclusions as presented in the document:

ALL of the following

For non-musculoskeletal disorders (infantile colic, asthma, otitis media, hypertension, primary dysmenorrhea, migraine, etc.), randomized trials of spinal/osteopathic manipulation show no superiority to sham; evidence does not support use for these indications.
Osteopathic manipulative treatment (OMT) evidence is heterogeneous; some small RCTs and systematic reviews show possible benefit for select outcomes, but overall evidence is low-to-moderate quality and not generalizable.
Visceral manipulation evidence is limited and inconsistent: some small RCTs report statistical improvement in specific outcomes, but clinical relevance and reproducibility are uncertain.
Craniosacral therapy (CST) evidence: multiple systematic reviews and meta-analyses report no consistent clinically relevant benefit across musculoskeletal or non-musculoskeletal conditions; evidence quality is generally poor; CST considered unproven.
Neuroimmunoendocrine claims (manipulation confers/enhances immunity) are unsupported—no credible scientific evidence.
Many positive individual-study findings are limited by small samples, poor blinding, heterogeneity, risk of bias, and short follow-up; additional high-quality RCTs are needed for validation.

The initial visit must include a treatment plan that documents: level of care (duration and frequency), treatment goals, and measures to assess effectiveness (qualitative and/or quantitative).

Follow-up visits must include information on the enrollee's progress in the treatment plan and the measures used to assess effectiveness.

ALL of the following

Policy effective dates: September 1, 2025 - March 31, 2026; retired April 1, 2026 (Louisiana membership disenrolled).

This policy is a state-specific UnitedHealthcare Community Plan medical policy that applies only to the state of Louisiana (see Application). The documented effective date range for this version is September 1, 2025 – March 31, 2026 and the policy file notes that it was retired effective April 1, 2026 for Louisiana plan membership.

As a Louisiana-only policy, state-mandated content is included (for example, EPSDT referral requirements for chiropractic services in enrollees under 21 and specific documentation and coverage rules for adult chiropractic and osteopathic manipulative services). Users should apply applicable federal, state, or contractual requirements when making coverage decisions and note that this policy version has been archived/retired as of April 1, 2026.

Maintenance care — ongoing periodic manipulative therapy intended to prevent recurrence or maintain improvement.

OMTOsteopathic manipulative treatment — manual techniques performed by osteopathic practitioners.

Non-state-specific terminology revised to specify 'Osteopathic Manipulative Therapy' in coverage rationale and a definition for 'Upledger Technique' was added.

2025-09-01literature update

Supporting information: Clinical Evidence and References sections updated to reflect current citations.

2025-09-01documentation clarification

Clarified required documentation for initial and follow-up visits for adult chiropractic services, including treatment plan content, treatment goals, and measures to assess effectiveness.

Manipulative Therapy (for Louisiana Only) Retired April 1, 2026

When Manipulative Therapy Is Covered or Not Covered

Documentation, Prior Auth, and Denial Risks — What Providers Must Do

Procedure Codes Referenced and State Fee-Schedule Exclusions

Clinical Background and Evidence Summaries by Condition

Louisiana-Specific Coverage Clarifications and Requirements

Definitions of Terms Used in This Policy

Policy Changes and Retirement Notes

Other Policies to Review